BCBS & Anthem Are Denying Lactation Claims — Here’s What Every Family Should Know

Why BCBS & Anthem Suddenly Stopped Covering Lactation Care — And What You Can Do About It

If you’re a Blue Cross Blue Shield or Anthem member in San Diego County — or anywhere in California — and you’ve recently tried to book lactation support, you may have run into a wall. We want to walk you through exactly what happened, why it matters, and what your options are right now.

What happened

With no warning and no transition period, BCBS and Anthem informed lactation providers across the county and the entire state — including us — that they would no longer be paying claims for IBCLC (International Board Certified Lactation Consultant) care. Overnight, providers who had been in-network were told their claims would simply be denied going forward.

We want to be honest: we’re disappointed. Families rely on this coverage during one of the most vulnerable seasons of new parenthood, and losing it without notice isn’t just an administrative inconvenience — it’s a real barrier to care.

This should be covered — here’s why

Lactation support is not a luxury benefit. Under the Affordable Care Act (ACA), lactation counseling and equipment are considered preventive services and are legally required to be covered by most insurance plans at no cost to you, both during pregnancy and after birth. That protection doesn’t disappear just because an insurer decides to narrow coverage overnight. If you’re being denied coverage for IBCLC care, it’s worth knowing that this is very likely happening in spite of what the ACA requires — not because of some new rule that makes it acceptable.

Why your voice matters here

Insurance companies respond to member pressure far more than they respond to provider complaints. If you have BCBS or Anthem, we’d genuinely encourage you to call the number on the back of your card and ask directly: why are there no in-network IBCLCs available to me?

A few things worth asking when you call:

• Why lactation claims are being denied despite ACA preventive care requirements
• Whether they can name a single in-network IBCLC in your area (often, they can’t)
• How to file a formal grievance or appeal if your claim is denied
• Whether your plan is fully insured or self-funded, which affects which rules apply

Every call adds a data point. Enough of them, and it becomes a pattern insurers can’t ignore.

Your options right now

If you have an appointment with us booked further out and haven’t heard from our team directly yet, here’s where things stand:

Option 1 — Self-pay rate. You can switch to our self-pay rate, which will actually come out lower than what you’d be billed once your insurance denies the claim in-network.

Option 2 — Superbill submission. We can provide you with a superbill — an itemized receipt with the clinical codes and diagnosis information insurance companies need — and advocate directly with BCBS or Anthem for your out-of-pocket reimbursement.

What is a superbill, exactly?

A superbill is essentially a detailed invoice that includes everything your insurance company needs to process an out-of-network reimbursement claim: your diagnosis code, the procedure codes for the services provided, the date of service, and our provider information. You pay us directly at the time of service, then submit the superbill to your insurance company yourself (or we help walk you through it). Some plans reimburse a portion of out-of-network costs even when they won’t pay in-network claims directly — it’s worth checking your specific plan’s out-of-network benefits.

Why private practice IBCLCs offer something different

We also want to name something that gets lost in this whole conversation: private practice IBCLCs and hospital-based IBCLCs are not interchangeable, and losing access to private practice care is a real loss — not just a paperwork inconvenience.

Hospital-based lactation support is invaluable in those first hours and days after birth. But feeding doesn’t stop mattering once you’re discharged. It evolves — through cluster feeding, growth spurts, return to work, introducing bottles, weaning, starting solids, tongue ties that surface weeks later, supply changes, and a hundred other things that unfold over the first year of a baby’s life, not just the first few days.

Private practice IBCLCs are able to:

• See you in your home, in the environment where feeding is actually happening
• Follow you longitudinally, across months, not just a single hospital stay
• Spend real, unrushed time with you — something hospital schedules rarely allow
• Coordinate care alongside pediatricians, OBs, and — in our case — registered dietitians, for a fuller picture of feeding and nutrition together

Families don’t stop needing support once they leave the hospital. If anything, that’s often when the real questions start.

We’re still here

We know this is frustrating, and we want you to know we’re not sitting on the sidelines. We’re actively advocating on behalf of our families for the coverage you’re entitled to, and we’ll keep you updated as anything changes. In the meantime, if you need support:

• Reach out to local breastfeeding support groups in your area, come join ours at New Mom School Encinitas! Every week @ 11:30am, free and open to the community, register here
• Call your local hospital directly to ask about accessing lactation care through their outpatient services
• Contact us — we’ll walk you through your self-pay or superbill options and make sure you’re not navigating this alone

And if you’re looking for extra support at home in the meantime, our team would be honored to support you.

You deserve continuous, high-quality feeding support — not coverage that disappears overnight. We’re going to keep fighting for that, for you.

~ Jaren & WWN Team